Pennsylvania Medicaid laws and regulations Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for April 17

The following is an update of selected state health policy developments in Pennsylvania from April 13 –April 17 (Some of the language used below is taken directly from state documents).

General Assembly

The House held session earlier week addressing the following issues:

Monday
- The House Judiciary Committee voted out HB 1104, proposing to cap fees for obtaining medical records, by a margin of 14-12.
- The House Human Services Committee held an informational hearing on the impacts of HR 1 on the SNAP Program in PA.
Tuesday
- The House Health Committee held a voting meeting on HB 836, preserving access to fertility treatment, which passed out of committee with amendment by a measure of 17-9 and HB 2254, which would allow for medical marijuana usage in licensed healthcare facilities passed 22-3; along with several resolutions. HB 916, providing for further Blood Lead Testing was to be considered but was passed over.
- The House Aging & Older Adult Services Committee held an informational hearing on the LIFE Program. The hearing highlighted the current state of the program in PA and nationally, aired enrollment challenges experienced by providers, and vetted potential legislative and policy solutions that could help address barriers to care.
- The House Democratic Policy Committee held a public hearing on Black Maternal Health and Hospital Accountability.

The Senate is scheduled to return to session this upcoming week. The House will return to session on April 27^th.

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Rep. Bridget Kosierowski circulated a cosponsor memo for legislation to ensure commercial and government insurance plan coverage for orthotics and prosthetics and another cosponsor memo requiring coverage of fertility preservation for cancer patients.
A cosponsor memo released by Rep. Maureen Madden providing for dementia training for EMS personnel.
Rep. Melissa Cerrato issued a cosponsor memo for legislation to require DHS to submit a waiver request to CMS to allow legally responsible family members to perform paid care for a care-dependent relative.
Rep. Maureen Madden introduced HB 2378, which would expand flu vaccine availability for patients age 50 and older.
HB 2379, sponsored by Rep. Marla Brown, would require continuing education in Trauma-Informed Maternity Care.
Rep. Rob Kauffman introduced HB 2399, which would place additional identification requirements for public assistance benefits.
Sen. Tracy Pennycuick introduced SB 1285, to establish the PA BioBonds Innovation Fund to help spur further bio-tech and life-sciences investment.

Department of Human Services

Check out DHS’ Human Services Helpers, on the Substack platform – a media platform for video, podcasts, etc. – that will cover updates on DHS programs, news from the agency, and how organizations and partners can help their communities.

Recently highlighted in DHS’ Human Services Helpers Substack was a toolkit for Long-Term Care Services & Caregivers to help all parties better understand and navigate the enrollment process.

DHS issued its May 2026 Remittance Advice Dates.

PA Healthcare Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) announced the release of new data detailing ownership of hospitals and ambulatory surgery centers (ASCs) across Pennsylvania, along with updated access to care information on facility locations and services for hospitals, ASCs, and nursing homes.

Stakeholder Meetings

The Patient Safety Authority will hold a public meeting on April 28^th at 1pm.

DOH’s Special Pharmaceutical Benefits Program will hold a public teleconference on April 30^th from 10am to Noon.

The Department of Health’s Spinal Cord Research Advisory Committee Meeting will hold a public meeting on May 1^st from 9am – 10am and the Brain Injury Advisory Board Meeting will also hold their public meeting on May 1^st from 10am – 3pm.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-04-17T19:33:18+00:00April 17th, 2026|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Health Policy Update for April 10

The following is an update of selected state health policy developments in Pennsylvania from April 6 –April 10 (Some of the language used below is taken directly from state documents).

General Assembly

The House returns to session next week where we anticipate the following actions:

Monday
- The House Judiciary Committee is scheduled to vote on several bills, one of which is HB 1104 which proposed to cap fees for obtaining medical records.
- The House Human Services Committee will hold a hearing on the impacts of HR 1 on the SNAP Program in PA.
Tuesday
- The House Health Committee will hold a hearing on HB 836, preserving access to fertility treatment; HB 916, providing for further Blood Lead Testing; and HB 2254, which would allow for medical marijuana usage in licensed healthcare facilities; along with several resolutions.
- The House Aging & Older Adult Services Committee will hold an informational hearing on the LIFE Program.
- The House Democratic Policy Committee will hold a public hearing on Black Maternal Health and Hospital Accountability.

The Senate is scheduled to return to session the following week.

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Rep. Danilo Burgos introduced House Bill 2368 to create the Healthcare Human Trafficking Screening and Intervention Act to provider greater structure and increased requirements for human trafficking intervention protocols.
House Bill 2364, introduced by Rep. Nikki Rivera would expand the scope of physical therapy services to include dry needling.
Sen. Tracy Pennycuick released a co-sponsor memo for legislation to require drug & alcohol recovery residences to obtain licensure within three years.
A co-sponsor memo was released by Sen. Maria Collett for legislation to create a Commission on Comprehensive Health Coverage.

Department of Human Services

DHS issued a Medical Assistance Bulletin for Prior Authorization Guidelines for Pediatric Adaptive Seating Equipment.

The Department shared remittance advice alerts for Fee-for-Service Relative Weight Adjustments.

Governor’s Advisory Commission on Women

The Governor’s Advisory Commission on Women has released a “State of the Woman” Survey to assess the experiences of women living in the Commonwealth. The survey is open through May 30^th.

State Board of Pharmacy

The State Board of Pharmacy issued notice of final deemed approved regulations on Injectable Medications.

Independent Fiscal Office

The Independent Fiscal Office provided a state budget and economic update to the Education Policy and Leadership Center. The report highlights state population decline and migration, limited job growth with the largest driver being the health care sector, and state general fund revenue and spending trends. The presentation can be found here.

Stakeholder Meetings

The Department of Health’s Renal Advisory Committee will hold their quarterly public meeting on April 17^th from 10am-Noon.

The Patient Safety Authority will hold a public meeting on April 28^th at 1pm.

DOH’s Special Pharmaceutical Benefits Program will hold a public teleconference on April 30^th from 10am to Noon.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-04-10T21:18:43+00:00April 10th, 2026|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for February 20

The following is an update of selected state health policy developments in Pennsylvania from February 16 – February 20 (Some of the language used below is taken directly from state documents).

General Assembly

Senate and House Appropriations Committee Hearings relevant to healthcare and human services are underway this upcoming week with key hearings are as follows:

Insurance Department: House – Feb. 24^th at 10am
Department of Health & Department of Drug & Alcohol Programs: House – Feb. 24^th at 1pm
Department of Human Services: Senate – Feb. 25^th at 10am; House – Mar. 4^th at 10am
Department of Aging: House – Mar. 10^th at 1pm
Governor’s Budget Office: Senate – Mar. 4^th at 1pm; House – Mar. 12^th at 10am

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Rep. Frank Burns released a co-sponsor memo for legislation requiring prescriptions for MA recipients to be filled by any pharmacist in good federal & state standing.
Rep. Bridget Kosierowski and Rep. Natalie Mihalek issued a co-sponsor memo for legislation allowing the coverage of medically-tailored meals prescribed for Medicaid recipients.
A co-sponsor memo circulated by Senators Lynda Schlegel Culver and Nick Pisciottano

would provide for legislation to regulate and license medical imaging and radiation therapy.

Sen. Doug Mastriano has issued a co-sponsor memo for legislation to enhance EMS within PA by elevating the EMS Director position in DOH to a Deputy Secretary role, along with additional regulatory flexibilities and educational requirement changes.
PBM reforms highlighted in a co-sponsor memo released by Senators Wayne Langerholc, Judy Ward, and Pat Stefano would institute Attorney General reviews to the PBM contracting and adjudication process, allowing PBMs to appear in PA courts for legal cause of action, among other reforms expanding on the PBM reforms of Act 77 of 2024.
Rep. Emily Kinkead introduced House Bill 2226 which would ensure that all patient out of pocket costs like co-pays and other assistance are credited towards out-of-pocket cost limits of insurance plans.

Department of Human Services

DHS released 2026 Income Limits for presumptive eligibility of pregnant women in Medicaid.

The Department issued its March 2026 remittance advice as well as remittance advice for date of death recovery.

Independent Regulatory Review Commission

The Commission will review proposed updates to the State Board of Pharmacy’s Final Immunization Regulation Updates at a public meeting on March 19^th at 10am.

Stakeholder Meetings

The Department of Health’s Newborn Screening and Follow Up Technical Advisory Board will meet on March 3^rd from 10am to Noon.

DOH’s Medical marijuana Advisory Board released their schedule of board meetings for 2026 with the first upcoming on March 26^th from 10:30am to 12:30pm.

The Department of Health’s WIC Advisory Board will hold their meeting rescheduled from January 26^th on March 5^th from 1pm to 2pm.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-02-20T21:51:13+00:00February 20th, 2026|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for February 6

The following is an update of selected state health policy developments in Pennsylvania from February 2 – February 6 (Some of the language used below is taken directly from state documents).

Budget Update

Governor Shapiro issued his fourth budget address before a joint session of the House and Senate this past Tuesday, sharing his priorities for the 2026-2027 Fiscal Year Budget. In total, the FY 2026-2027 budget proposes spending $53.26 billion, $2.7 billion more than the current fiscal year. The proposed budget, which exceeds anticipated revenues by $4.6 billion, represents a $2.72 billion, or a 5.4 percent, increase over the prior fiscal year. The budget is balanced primarily by utilizing $4.6 billion in Rainy Day Fund reserves, leaving approximately $3 billion in the fund’s balance. This budget does not include a broad-based tax increase but it once again proposes legalization and taxation of skill games and recreational adult use cannabis and raising the minimum wage to $15 per hour.

General Assembly

The House and Senate both were in session this week but will break from session until March 23^rd for the House and March 16^th for the Senate. Both the House and Senate Appropriations Committees will begin their hearings to examine the Governor’s Budget Proposal. Key hearings are as follows:

Insurance Department: House – Feb. 24^th at 10am

Department of Health & Department of Drug & Alcohol Programs: House – Feb. 24^th at 1pm

Department of Human Services: Senate – Feb. 25^th at 10am; House – Mar. 4^th at 10am

Department of Aging: House – Mar. 10^th at 1pm

Governor’s Budget Office: Senate – Mar. 4^th at 1pm; House – Mar. 12^th at 10am

Dates for all five special elections to fill vacancies in the House have now been scheduled. House District 22 in Lehigh County & House District 42 in Allegheny County are scheduled for February 24^th. Elections for House District 79 in Blair County and House District 193 in Adams County will be held on March 17^th. Lastly, the special election for the vacancy in York County’s House District 196 will be on May 19^th to coincide with this year’s primary election.

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Rep. Bridget Kosierowski and Rep. Jim Struzzi released a co-sponsor memo for legislation directing the Legislative Budget & Finance Committee (LBFC) to study the financial and administrative impacts of compliance with hospital regulations, and recommend action on any duplicative or outdated regulations currently in effect.
Rep. Joe Webster issued a co-sponsor memo soliciting support for legislation banning facility fees for outpatient services by healthcare providers and creating “site-neutral” payment caps.
In support of Gov. Shapiro’s Innovate PA 2.0 budget priority, Rep. Tim Briggs circulated a co-sponsor memo in the House for legislation to implement the program and Chairman Vince Hughes released a corresponding version in the Senate.
Sen. Michele Brooks has also released a co-sponsor memo directing the Legislative Budget & Finance Committee (LBFC) to study the burden of regulations on healthcare facilities and providers in PA.
Sen. Tracy Pennycuick and Sen. Frank Farry issued a co-sponsor memo for legislation to establish the Biobonds Innovation Fund, modeled after the federal “Loans for Biomedical Research Act.”
Reps. Emily Kinkead, Andrew Kuzma, Tarik Khan, Liz Hanbidge, and Darisha Parker have issued a co-sponsor memo for legislation prohibiting co-pay accumulator policies.

Department of Human Services

DHS issued Medical Assistance prior authorization guidance for the following:

DHS’ Office of Mental Health & Substance Abuse Services (OMHSAS) issued an MA Fee Schedule Bulletin announcing the addition of Psychiatric Rehabilitation Services to the MA Fee Schedule.

Independent Regulatory Review Commission

Independent Regulatory Review Commission issued comments to the DHS’ proposed Mental Health Procedures Regulations.

Stakeholder Meetings

The Patient Safety Authority will hold a public board meeting on Tues. Feb. 10^th at 1pm.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-02-10T21:33:52+00:00February 6th, 2026|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2027 budget|Comments Off

PA Health Policy Update for January 30

The following is an update of selected state health policy developments in Pennsylvania from January 26 – January 30 (Some of the language used below is taken directly from state documents).

Governor’s Office

Governor Shapiro will offer his annual budget address, laying out his priorities for the 2026-2027 Fiscal Year Budget, before a joint session of the House and Senate on Tuesday Feb. 3^rd. You can watch the address live at 11am on Tuesday.

The Governor’s Office of Policy & Planning released its updated Regulatory Agenda detailing estimated timelines for the release of proposed or final regulations to the Independent Regulatory Review Commission. The Department of Health estimates that it will publish proposed changes to the hospital regulations in May 2026.

General Assembly

The House and Senate will both convene next week in session Monday through Wednesday and will convene in joint session for the Governor’s Budget Address Tuesday morning.

The House also has another vacancy as Rep. Seth Grove of York County resigned his office effective January 31st. Rep. Grove most recently chaired the House Labor & Industry Committee and previously chaired the House Appropriations Committee. Until special elections are finalized this leaves the House with five vacancies and a balance of power at 100 (D) – 98 (R).

The House passed HB 348, sponsored by Rep. Tim Bonner, by a measure of 199-0. This legislation would require nursing facilities to make residents aware of the option to have legal counsel assist residents with their eligibility for Medical Assistance. The bill now moves to the Senate for its consideration.

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Rep. Justin Fleming issued a co-sponsor memo for legislation to create a tax credit program for Direct Support Professionals.
Rep. Brenda Pugh released two emergency services-related co-sponsor memos. The first would require additional transparency for the Emergency Services Operating Fund (EMSOF) and the other would create a Fire & EMS Recruitment & Retention Grant program.
A co-sponsor memo released by Rep. Kyle Mullins and Rep. Bryan Cutler would create regulations and licensure requirements for medical imaging professionals.
Representatives Lisa Borowski, Paul Friel, and Thomas Kutz introduced HB 2162 which would allow for companies to apply for a state pharmaceutical licensure concurrently with FDA approvals.
Rep. Bridget Kosierowski introduced HB 2164 which would create a Complex Care Assistant certification for family members of medically fragile children.
Sen. Cris Dush released a co-sponsor memo directing the Legislative Budget & Finance Committee to perform a study examining the PA Medicaid program.
Senators Katie Muth, Lindsey Williams, and Nikil Saval circulated a co-sponsor memo establishing combined tax reporting for businesses in Pennsylvania.
Sen. Maria Collett released a co-sponsor memo for legislation maintaining coverage for Affordable Care Act- required preventative services.

Department of Drug & Alcohol Programs

The Department highlighted nine grants totaling $1.9M for Single County Authorities supporting fourteen counties to support the expansion and development of recovery houses and recovery support services.

Department of Health

DOH issued notice of the inclusion of Deuchenne’s Muscular Dystrophy to the Recommended Uniform Screening Panel (RUSP) supplemental conditions list for the Newborn Screening Program effective Jan. 1, 2027.

Department of Human Services

DHS issued notice of Medical Assistance Day One Incentive (MDOI) payments for nonpublic nursing facilities.

The Department released notice of renewal of the OBRA Waiver and the Community Health Choices Waiver. Both waiver updates would add teleservice delivery, behavior therapy, and benefits counseling, among others.

DHS shared Prior Authorization guidelines for Manual Hospital Beds and Accessories and Face and Ear Prosthesis.

PA Health Care Cost Containment Council

PHC4 issued a report detailing data behind the closures of Brandywine Hospital and Jennersville Hospital.

Independent Fiscal Office

The Independent Fiscal Office released its 2026 Mid-Year Revenue Update. The report details prior revenue estimates vs actual revenues for the Commonwealth. The IFO continues to issue caution on a structural deficit for the Commonwealth at current spending & revenue levels.

Joint State Government Commission

As directed by House Resolution 170 of 2023, the Joint State Government Commission released a report and advisory committee recommendations on the Adoption and Use of Artificial Intelligence in Pennsylvania.

Stakeholder Meetings

The Department of Health’s Organ Donation Advisory Committee will meet on Thurs. Feb. 5^th at 10am.

DOH’s Brain Injury Advisory Board will hold a public meeting on Fri. Feb. 6^th from 10am to 3pm.

The Patient Safety Authority will hold a public board meeting on Tues. Feb. 10^th at 1pm.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-01-30T21:48:31+00:00January 30th, 2026|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2027 budget, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for January 23

The following is an update of selected state health policy developments in Pennsylvania from January 19 – January 23 (Some of the language used below is taken directly from state documents).

Hospital Sustainability

The Hospital & Healthsystem Association of Pennsylvania released a commissioned report on the sustainability of PA hospitals over the next five years which details challenges faced by hospitals and opportunities to preserve healthcare access. The report and a fact sheet are available online

General Assembly

The House and Senate will both convene next week in session for an abbreviated time due to the impending snowstorm. The House cancelled Monday and Tuesday session and will convene for one day on Wednesday the 28^th. As of this writing, the Senate is still planning on a full session week but that is subject to weather cancellations or delays.

The House plans to vote on HB 348, sponsored by Rep. Tim Bonner, which would require nursing facilities to make residents aware of the option to have legal counsel assist residents with their eligibility for Medical Assistance.

The following are healthcare-related bills or cosponsor memos released by legislators this past week:

Senators Chris Gebhard and Cris Dush released a co-sponsor memo to prohibit state funds going to entities providing gender affirming care to children.
Sen. Doug Mastriano, Sen. Michele Brooks, and Sen. Lisa Baker introduced SB 1147 which allows for Medicaid reimbursement of EMS treatment without transport
Sen. Pennycuick, Sen. Bartolotta, and Sen. Devlin Robinson introduced a co-sponsor memo for legislation to allow veterans the “right-to-try” psilocybin-assisted therapies and SB 1149, which would automatically align Pennsylvania’s drug scheduling with Federal scheduling of psilocybin if any change is made.

Department of Human Services

DHS released its Managed Care Enrollment information for December 2025.

The Department shared its remittance guidance for February 2026.

Stakeholder Meetings

DOH’s WIC State Advisory Board meeting will be held on Tues. Jan. 27^th from 1-2pm.

The Department of Health’s Special Pharmaceutical Benefit Program Advisory Council will meet on Thurs. Jan. 29 from 10a.m. to 12p.m. The Council will offer guidance and recommendations to the Department on the program’s drug formulary, covered lab services, drug utilization review, clinical programs, eligibility and program management.

DOH’s Brain Injury Advisory Board will hold a public meeting on Fri. Feb. 6^th from 10am to 3pm.

The Patient Safety Authority will hold a public board meeting on Tues. Feb. 10^th at 1pm.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2026-01-23T21:20:13+00:00January 23rd, 2026|Advocacy, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for December 19

The following is an update of selected state health policy developments in Pennsylvania from December 15 – December 19 (Some of the language used below is taken directly from state documents).

SNAP Eligibility Screening Tool

DHS issued a new screening tool designed to help Pennsylvanians determine their eligibility for SNAP benefits. This tool follows new federal rules implemented by the One Big Beautiful Bill Act which changed eligibility requirements for public assistance programs such as SNAP.

General Assembly

The House concluded its voting days for the remainder of the year. As the year concludes, so does the tenure of service for some in the legislature. State Representatives Dan Miller in Allegheny County and Josh Siegel in Lehigh County both have tendered resignations to the Speaker to assume local offices won in November’s elections. The Speaker has set dates for special elections on Feb. 24^th to replace these members. Two additional resignations will also be forthcoming between now and early 2026 for Reps. Torren Ecker of Adams County and Lou Schmitt of Blair County, also to assume local elected positions.

During House Session this week, the House Communications & Technology Committee held a public hearing on HB 1925, Rep. Arvind Venkat’s AI in Healthcare legislation. The hearing can be viewed here.

The House Health Committee unanimously voted out both HB 1202 & HB 1851 this week. Rep. David Zimmerman’s HB 1202 would create a Commonwealth Medical Stockpile which could be accessed by healthcare facilities. HB 1851, sponsored by Rep. Gina Curry, would allow nurse-midwives to sign fetal death certificates.

Additionally, the House acted on the following healthcare-related bills this week:

Receiving Second Consideration
- HB 348, by Rep. Tim Bonner, which requires nursing facilities to make residents and their families aware of their rights and options to apply for Medicaid benefits at the time of entering a nursing home;
- HB 1129, sponsored by Rep. Paul Friel, which provides for the sale of Net Operating Losses and unused Research & Development Tax Credits.
Final Passage from the House
- HB 1530, by Rep. Danilo Burgos, which establishes privacy protections for Pennsylvania consumers regarding their genetic data collected by direct-to-consumer genetic testing companies (e.g., commercial DNA testing services). This bill was passed unanimously.
- HB 1957, by Rep. Melissa Shusterman, which would establish the reproductive right in the Pennsylvania Constitution. This legislation passed 102-101.
- HB 1881, by Rep. Arvind Venkat, passed 106-97. This bill would mirror an executive order by Governor Shapiro, allowing pharmacists’ practice authority to provide vaccines recommended by Pennsylvania’s health authorities that may be informed by our professional medical societies.

Department of Human Services

DHS launched Human Services Helpers, on the Substack platform – a media platform for video, podcasts, etc. – that will cover updates on DHS programs, news from the agency, and how organizations and partners can help their communities.

The Department issued an MA Bulletin regarding prior authorization for Lynkuet.

DHS updates to the Pennsylvania Medicaid Managed Care Directory and issued its MCO Enrollment Report for November 2025.

The Shapiro Administration announced the launching of a suite of new technology and tools to support the Commonwealth’s administration and management of public assistance programs and improve customer experience.

State Board of Pharmacy

The State Board of Pharmacy proposed rulemaking that sets forth the board’s criteria for eligibility for licensure by endorsement, including the specific methods required for an applicant to demonstrate competency. It also sets forth the requirements for granting a provisional endorsement license.

Independent Fiscal Office

The IFO published a new budget brief that uses the latest SNAP benefits data for November 2025. The data show that the number of enrollees declined by 158,000 (-8%) from the prior year as new work requirements take effect.

Stakeholder Meetings

The Department of Health’s Renal Disease Advisory Committee will meet for its quarterly public meeting on Friday, January 16, 2026, from 10 a.m. to 12 p.m.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2025-12-19T21:18:56+00:00December 19th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for September 5

The following is an update of selected state health policy developments in Pennsylvania from September 1 – 5 (Some of the language used below is taken directly from state and federal documents).

Fiscal Year 2025-26 Budget Update

There was no legislative activity surrounding the state budget this week. Governor Shapiro sent a compromise budget proposal to Senate Republican leadership last week, but they have yet to take any action. The Senate is scheduled to return to session next week on September 8, but that date could be pushed back if an agreement is not ready.

The House stands adjourned until September 22.

Department of Health

The Department of Health (DOH) issued interpretative guidance to clarify staffing regulations for hospitals, allowing for flexible physician coverage models while maintaining patient safety and regulatory compliance. It focuses on on-site, on-call, and telemedicine-based physician coverage requirements. Review the full document here.

Department of State

The State Board of Pharmacy met this week and voted to approve four new entities as “competent authorities” to issue guidelines for licensed pharmacists under 49 PA Code § 27.403 on the use of injectable immunizations. This action was taken in anticipation of changes from the Centers for Disease Control’s upcoming vaccine committee meeting and will permit pharmacists to continue providing COVID-19 vaccinations, which had been paused by some providers. Find a news release about the voting meeting here.

Department of Human Services

The Department of Human Services (DHS) updated its list of Remittance Advices with an updated participating drug company list for the Medicaid Drug Rebate Program. Find the updated list here.

The Offices of Long-Term Living and Medical Assistance Programs issued a Medical Assistance bulletin alerting providers that it will begin issuing electronic visit verification (EVV) alerts to providers whose EVV manual entry percentages exceed 15 percent for the previous quarter. These alerts will be sent directly by DHS for fee-for-service claims and the department will transmit a list of noncompliant providers to the appropriate managed care organizations for awareness and follow up.

The Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) Letter jointly developed by CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA). This SHO provides guidance to states on the best practices for implementing the continuum of crisis services. It describes specific Medicaid and CHIP authorities and flexibilities to support the full continuum of crisis response services and suggests strategies for measuring and monitoring crisis response services.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 released a new interactive map displaying access to care in different counties, called MAPPED 2. This resource includes hospitals, ambulatory surgery centers, and nursing homes. It was designed to help patients, legislators, and health care providers learn more about the health care landscape of Pennsylvania.

Around the State

A Philadelphia judge has directed SEPTA to immediately reverse all service cuts imposed last month. WHYY reports on the decision in this article.
The Penn Capital Star reported on the state pharmacy board’s decision this week to permit additional professional organizations to issue guidance for immunizations.
An article from the Altoona Mirror details the financial strain and difficult decisions that are facing county providers and non-profits now that the state budget is two months late.

Stakeholder Meetings

DHS Statewide Positive Approaches & Practices Conference – September 17

This quarterly meeting is jointly hosted by The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP). It aims to provide the most recent research and resources for people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities to live an everyday life. The meeting is held virtually from 10am to 3pm. For details and registration, click here.

Dual Diagnosis Professional Conference Series – September 18

Jointly hosted by OMHSAS and ODP, this presentation will review the clinical clues for identifying the effects of fetal alcohol spectrum disorder, suggestions for screening, current research, and statistics. The meeting is held virtually from 9am to 12:30pm. Click here to register.

PA Safety Net Admin2025-09-05T19:11:23+00:00September 5th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for July 3

The following is an update of selected state health policy developments in Pennsylvania from June 30 – July 3. (Some of the language used below is taken directly from state documents).

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders have yet to reach a final agreement on the commonwealth’s Fiscal Year (FY) 2025-26 spending plan. In a statement released by Senate Republican leadership, they indicated they’ll continue to “work with all parties to reach a final agreement.” Governor Shapiro and House Democratic leadership have indicated an agreement may be possible in the coming weeks. Presently, the Senate is recessed until the call of the chair and the House is scheduled to return to Harrisburg on Monday, July 7.

Governor Shapiro

Governor Shapiro has signed into law House Bill 640, which is now known as Act 14 of 2025. Act 14 updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP) and eliminates the sunset date of the state’s provider assessments in anticipation of certain changes to provider assessments being contemplated by the U.S. Congress.

Governor Shapiro has signed Senate Bill 411 into law. Act 24 of 2025, as it’s now known, provides the ability for the Pennsylvania Department of Health to create and utilize a stroke registry.

The Shapiro administration has released a document with estimates regarding how many Pennsylvanians may lose Medicaid and SNAP benefits as a result of the reconciliation package being considered by the U.S. Congress.

General Assembly

The state House of Representatives and Senate briefly convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity that occurred.

The Senate voted to concur with the House amendments to Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed. The bill also places certain disclosure requirements on pharmacies related to the retail and generic versions of prescribed medications and allows for the provisional licensing of pharmacists. The bill has been presented to Governor Shapiro for his signature.

The House of Representatives passed House Bill 1234, which expands the Medical Assistance (MA) program to cover blood pressure monitors for home use as a pregnancy-related service on a per pregnancy basis. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 482, which authorizes Pennsylvania to join the National Occupational Therapy Licensure Compact. The bill will now be sent to the Senate for consideration.

The House of Representatives voted to concur with the Senate’s amendments to House Bill 309, which amends the Osteopathic Medical Practice Act to allow team physicians traveling internationally with their club or national team to treat their own players on site during games without needing a Pennsylvania medical license. The bill was subsequently presented to Governor Shapiro for his signature.

The House Labor & Industry Committee met on Tuesday, July 1 and favorably reported House Bill 1676, which establishes the Nursing Shortage Assistance Program. A recording of the meeting is viewable here.

The House Health Committee met on Tuesday, July 1 and favorably reported Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028. A recording of the meeting is viewable here.

The House Finance Committee met on Monday, June 30 and favorably reported House Bill 1129, which allows early-stage technology and biotechnology businesses to sell their net operating losses (NOL) and unused research and development tax credits to unrelated companies. A recording of the meeting is viewable here.

The House of Representatives is currently scheduled to return to session on Monday, July 7. The Senate is recessed until the call of the chair.

Department of Human Services

The Department of Human Services (DHS) has published its annual list of exceptional Durable Medical Equipment (DME) for nursing facilities. Find the list and additional information in this Pennsylvania Bulletin notice.

DHS has issued an updated Pennsylvania Medicaid Managed Care Directory.

DHS has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of May 2025.

Department of Health

The Department of Health (DOH) has published notice that, effective July 1, 2025, ConcussionWise is no longer an approved concussion management certification training course. The only approved courses are through the Centers for Disease Control and Prevention (CDC) and the National Federation of State High School Associations (NFHS). Find additional information in this Pennsylvania Bulletin notice.

Revenue Collection Update

The Department of Revenue has announced that Pennsylvania ended the 2024-25 fiscal year with $46.4 billion in General Fund collections, which is $321 million, or 0.7 percent, above estimate. The Independent Fiscal Office’s (IFO) monthly revenue update for June 2025 is viewable here.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has announced that the agency recently issued Pennsylvania’s first telehealth exceptions for a DDAP-licensed substance use disorder (SUD) treatment provider. Prior to this, only SUD treatment facilities with a physical location in Pennsylvania could apply to DDAP for a license to also offer telehealth services. This new program does not require a physical location in order for a treatment provider to administer telehealth services.

Board of Medicine

The State Board of Medicine has published final-form rulemaking, which is effective upon publication in the Pennsylvania Bulletin, implementing Act 79 of 2021. This rulemaking modernizes physician assistant (PA) practice by removing certain restrictions and allowing for greater autonomy for PAs. Find additional information in this Pennsylvania Bulletin notice.

Board of Physical Therapy

The State Board of Physical Therapy has published final-form rulemaking regarding changes to the physical therapy examination process and continuing education requirements. Find the final rule in this Pennsylvania Bulletin notice.

Around the State

Spotlight PA has written an article about the increasing prevalence of Nitazines, a class of powerful synthetic opioids, and the Department of Health’s efforts to reschedule these drugs to limit access and allow prosecutors to charge suppliers.

The Philadelphia Inquirer has published an article about Pennsylvania’s late FY 2025-26 budget and what the immediate impact may be. CBS 21 has also published a piece of the status of the state budget.

PA Safety Net Admin2025-07-03T20:30:51+00:00July 3rd, 2025|Meetings and notices, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for June 13

The following is an update of selected state health policy developments in Pennsylvania from June 9 – 13. (Some of the language used below is taken directly from state documents).

General Assembly

The state House of Representatives and Senate convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity that occurred this week.

The Senate unanimously passed Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed. The bill also places certain disclosure requirements on pharmacies related to the retail and generic versions of prescribed medications. The bill was subsequently received in the House and referred to the Veterans Affairs and Emergency Preparedness Committee.

The House of Representatives passed House Bill 1549, which increases the state’s minimum wages, by a party-line vote. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 1460, which provides for more oversight of health care entity merger and acquisition activities. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 1088, which expands maternal blood pressure monitoring coverage. The bill will now be sent to the Senate for consideration.

The Senate Consumer Protection & Professional Licensure Committee met on Wednesday, June 11 and favorably reported, among other bills, Senate Bills 535 & 536, which amend the Osteopathic and Medical Practice Acts to enable genetic counselors to order genetic tests as appropriate.

The Senate Health & Human Services Committee met on Wednesday, June 11 and favorably reported, among other bills, the following.
- Senate Bill 461, which seeks to improve testing and insurance coverage for Lyme disease testing.
- Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028.
- House Bill 27, which requires operating rooms to utilize surgical smoke evacuation systems.
- House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP).

A recording of the meeting is viewable here.

The House Human Services Committee met on Tuesday, June 10 and favorably reported House Bill 1100, which creates a grant program to provide eligible public-school entities with funding to acquire and distribute menstrual hygiene products, and House Bill 1590, which supports Pennsylvania’s implementation of a new federal Medicaid flexibility that waives the longstanding “four walls” requirement for outpatient behavioral health clinics. A recording of the hearing is viewable here.

The House Health Committee met on Tuesday, June 10 and favorably reported House Bill 1442, which places requirements on coroners to report Sudden Unexpected Death in Epilepsy (SUDEP), and House Bill 1527, which extends the Rate Disease Advisory Council’s sunset date to 2028. A recording of the meeting is viewable here.

The House Aging & Older Adult Services Committee met on Tuesday, June 10 for an informational hearing on the Older Adult Protective Services Act (OAPSA) and financial exploitation of older adults. A recording of the hearing is viewable here.

The Legislative Budget & Finance Committee (LBFC) met on Wednesday, June 11 and released its report on the effect of home and community-based workforce shortages on commonwealth-supported Medicaid waiver programs. The full report is viewable here and highlights from the report are viewable here.

The state House of Representatives will reconvene in Harrisburg for voting on Monday, June 16. The Senate is recessed until Monday, June 23.

Department of Human Services

The Department of Human Services (DHS) has announced it will hold another listening session in its “Food is Medicine Stakeholder Engagement Series,” which is part of the Bridges to Success: Keystones of Health demonstration waiver. The next session, which will focus on medically tailored meals, will take place on June 16 at 1:00 p.m. Find additional information and registration details here.

DHS has issued a Medical Assistance Bulletin to inform providers about updates to the Statewide Preferred Drug List (PDL) related to glucose sticks made at the April 23 Pharmacy & Therapeutics (P&T) Committee meeting. The PDL changes are effective July 7, 2025.

DHS has announced changes to the Medical Assistance (MA) program fee schedule. The department is adding and end-dating codes as a result of the 2025 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The changes are effective for dates of service on and after June 16, 2025. Find additional information in this Pennsylvania Bulletin notice.

DHS has released a document with revisions to the participating drug companies list for the Medicaid Drug Rebate Program.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of July. Find the updated calendar here.

DHS has issued a Remittance Advice Alert regarding action needed to continue submitting claims and eligibility requests electronically with PROMISe™.

Department of Health

The Department of Health (DOH) has published notice of intent to issue a final notice to temporarily schedule any material, compound, mixture, or preparation which contains any quantity of the several Nitazene substances. This final notice to temporarily schedule will place this group of substances in Schedule I under The Controlled Substance, Drug, Device and Cosmetic Act.

Independent Fiscal Office

The Independent Fiscal Office (IFO) has published a budget brief highlighting Pennsylvania Medicaid enrollment and funding trends from FY 2018-19 through the administration’s proposal for FY 2025-26. It also provides projections of the impact for certain Medicaid provisions included in the federal reconciliation bill passed by the U.S. House of Representatives.

Insurance Department

The Pennsylvania Insurance Department (PID) has announced that the largest health insurers operating in the commonwealth are taking steps to expand coverage for medications used to treat postpartum depression and related maternal mental health conditions. Find additional information in this press release.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has shared an opportunity from the Health Resources and Services Administration (HRSA), the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program. The program offers up to $250,000 in student loan repayment for eligible professionals who commit to six years of full-time work providing direct SUD treatment or recovery support at an approved facility. The program is open to a range of providers, including medical, behavioral health, and peer support professionals. Applications are due July 10, 2025.

Around the State

Spotlight PA has published an article on the potential impact of the budget reconciliation bill being considered by the U.S. Congress on the state’s Medicaid program.

The Wall Street Journal has written an article about the Pennsylvania General Assembly’s efforts to enact legislation creating more scrutiny over health care entity transactions involving private equity.

LancasterOnline covered Senate Appropriations Committee Chairman Scott Martin’s comments about the state budget unpredictability created federal budget discussions.

Stakeholder Meetings

Pharmaceutical Assistance Advisory Board – June 16

The Department of Aging has announced the Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, June 16 from 1:00 p.m. to 2:30 p.m. Find information on how to participate in this Pennsylvania Bulletin notice.

Patient Safety Authority – June 17

The Patient Safety Authority has announced it will hold a meeting of the Authority’s board on Tuesday, June 17 at 1:00 p.m. The meeting will be held virtually and is open to the public. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Preventative Health Services Block Grant Advisory Committee – June 17

The Preventative Health and Health Services Block Grant Advisory Committee will hold a public meeting on Tuesday, June 17 from 9:30 a.m. to 10:30 a.m. The purpose of the meeting is to present the Federal Fiscal Year 2025 Workplan and budget information. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-06-13T19:46:49+00:00June 13th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

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